Provider Demographics
NPI:1225378789
Name:OSBURN, AUDREY (OTR/L)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:OSBURN
Suffix:
Gender:F
Credentials:OTR/L
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E HILLSDALE BLVD
Mailing Address - Street 2:APT 19B
Mailing Address - City:FOSTER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94404-1221
Mailing Address - Country:US
Mailing Address - Phone:317-502-8113
Mailing Address - Fax:
Practice Address - Street 1:1060 TWIN DOLPHIN DR
Practice Address - Street 2:SUITE 100
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94065-1133
Practice Address - Country:US
Practice Address - Phone:650-631-9999
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-02-20
Last Update Date:2014-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX115276225XP0200X
CA14527225XP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225XP0200XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOccupational TherapistPediatrics